Simpra Advantage Assist (PPO I-SNP) (2027)

Institutional Special Needs Plan (Medicare Advantage) from Simpra Advantage, plan ID H4091-003-000. Sold in 67 counties in Alabama.

★★★★★Not yet rated

Who can join

Only for people who live in a nursing home or similar facility, or need that level of care at home.

2027 costs

Monthly premium$90 ($15.60 of it for drug coverage)

Drug deductible$150

Medical deductible$0

Out-of-pocket maximum (in network)$6,700

Plan typeInstitutional Special Needs Plan (Medicare Advantage), PPO

Referral needed to see a specialistNo

Plan IDH4091-003-000

With a Medicare Advantage plan you also keep paying your Medicare Part B premium.

What this plan would cost for your prescriptions

Add your prescriptions to see this plan's estimated yearly cost for them, which of them are on its drug list, and how each compares with Cost Plus Drugs prices.

See this plan with my prescriptions

What you pay for medical care

Primary care visit$0

Specialist visit$30

Preventive care$0

Urgent care$30

Emergency room$90

Hospital stay$175/day

Outpatient surgery$30–$50

Lab tests20%

X-rays and scans$50

Mental health visit$30

Physical therapy$0

Medical equipment20%

TelehealthCovered

In-network amounts. A range means it depends on the service or provider.

Extra benefits

DentalCovered — up to $750 allowance

VisionCovered — up to $230/yr allowance

HearingCovered — up to $2000 every 2 yrs allowance

Over-the-counter itemsCovered — up to $200/quarter allowance

FitnessNot covered

Rides to appointmentsNot covered

Drug costs by tier

Tier	30 days, standard pharmacy	30 days, preferred pharmacy	90 days by mail
1 Preferred Generic	$0	$0	$0
2 Generic	$15	$15	$45
3 Preferred Brand	$45	$45	$135
4 Non-Preferred Drug	$95	$95	$285
5 Specialty Tier	31%	31%	31%

A percentage is coinsurance: your share of the drug's price. The drug deductible may apply first, depending on the tier. Your Part D out-of-pocket costs are capped at $2,400 for 2027.

Where it's sold

Alabama (67 counties)

Plan costs and benefits are from CMS's 2027 Medicare plan data (data as of October 27, 2026). Star ratings are CMS's 2027 Star Ratings. Every year, Medicare evaluates plans based on a 5-star rating system. Benefits, premiums and copays can change from year to year; check the plan's Evidence of Coverage, call the plan, or use Medicare.gov before you enroll.